What are the indications, contraindications, and dosages of the medications used in our hospital?

Hospital Medication Reference Guide

I cannot provide a comprehensive list of indications, contraindications, and dosages for all medications used in your hospital without knowing which specific drugs you're asking about. However, I can guide you on how to approach this systematically based on the evidence provided.

Framework for Medication Information

To obtain accurate prescribing information for any medication, you should prioritize the following sources in order:

• FDA-approved prescribing information (package inserts) - This is the primary authoritative source for indications, contraindications, dosing, and safety information 1, 2
• Current clinical practice guidelines from major professional societies (e.g., IDSA, ATS/ERS, ACC/AHA, ESC) - These provide evidence-based recommendations for specific clinical conditions 1
• Specialized dosing references for patients with organ dysfunction, particularly renal and hepatic impairment 1, 3, 4

Key Medication Categories from Available Evidence

Antimicrobials for Nontuberculous Mycobacterial Disease

The ATS/ERS/ESCMID/IDSA guidelines provide detailed dosing tables for multiple antimicrobials 1:

Oral agents:

• Azithromycin: 250-500 mg daily (or 500 mg three times weekly) 1
• Clarithromycin: 500 mg twice daily (reduce dose by 50% if CrCl <30 mL/min) 1
• Rifampicin: 10 mg/kg (450-600 mg) daily 1
• Ethambutol: 15 mg/kg daily (or 25 mg/kg three times weekly) 1
• Moxifloxacin: 400 mg daily 1
• Linezolid: 600 mg once or twice daily (once daily preferred due to toxicity) 1

Parenteral agents:

• Amikacin IV: 10-15 mg/kg daily with drug level monitoring (target trough <5 mg/L, peak 35-45 μg/mL for daily dosing) 1
• Imipenem IV: 500-1000 mg 2-3 times daily 1

Critical caveat: Ototoxicity risk is approximately 33% with prolonged aminoglycoside use, associated with age and cumulative dose 1

Cardiovascular Medications for STEMI

The ACCF/AHA guidelines specify dosing for acute coronary syndromes 1:

Beta-blockers (contraindicated in HF signs, low output state, cardiogenic shock risk, PR >0.24 seconds, high-grade AV block, active asthma):

• Metoprolol tartrate: 25-50 mg every 6-12 hours orally, titrate to 200 mg daily 1
• Carvedilol: 6.25 mg twice daily, titrate to 25 mg twice daily 1
• Metoprolol IV: 5 mg every 5 minutes up to 3 doses for refractory hypertension/ischemia 1

ACE inhibitors (avoid in hypotension, renal failure, hyperkalemia):

• Lisinopril: 2.5-5 mg daily, titrate to 10 mg daily or higher 1
• Ramipril: 2.5 mg twice daily, titrate to 5 mg twice daily 1

Statins:

• Atorvastatin: 80 mg daily (monitor for myopathy, hepatotoxicity, drug interactions via CYP3A4) 1

Antimicrobials for Multidrug-Resistant Organisms

The Taiwan guidelines for MRSA and MDR organisms provide specific regimens 1:

Vancomycin dosing:

• Loading dose: 25-30 mg/kg for seriously ill patients 1
• Maintenance: 30-60 mg/kg/day divided every 6-12 hours 1

For carbapenem-resistant Enterobacterales 1:

• Ceftazidime/avibactam: 2.5 g IV every 8 hours 1
• Meropenem/vaborbactam: 4 g IV every 8 hours 1
• Colistin: 5 mg CBA/kg IV loading dose, then 2.5 mg CBA × (1.5 × CrCl + 30) IV every 12 hours 1

For vancomycin-resistant Enterococci:

• Linezolid: 600 mg IV every 12 hours 1
• Daptomycin: 8-12 mg/kg IV daily 1

Renal Dose Adjustments

Multiple guidelines emphasize the critical importance of renal dose adjustment 1, 3, 4:

Common pitfall: Elderly patients often have decreased renal function despite normal serum creatinine 3

Meropenem in renal impairment:

• CRRT: 1 gram every 8 hours (CRRT removes 25-50% of drug) 4
• SLED: 1 gram every 12 hours post-dialysis 4
• For resistant organisms (MIC ≥8 mg/L): Extended 3-hour infusion recommended even in renal impairment 4

Trimethoprim-sulfamethoxazole:

• CrCl 15-30 mL/min: Reduce dose by 50% 1
• CrCl <15 mL/min: Reduce dose by 50% or use alternative 1

Essential Action Steps

For each medication in your hospital formulary, you must:

1. Obtain the current FDA-approved prescribing information 2
2. Cross-reference with relevant clinical practice guidelines for your patient populations 1
3. Establish protocols for renal and hepatic dose adjustments 1, 3, 4
4. Implement therapeutic drug monitoring where indicated (vancomycin, aminoglycosides) 1
5. Create institution-specific guidelines that account for local resistance patterns 1

Please specify which medications you need detailed information about, and I can provide comprehensive prescribing details for those specific agents.